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quality Research of care Improving the By Susan Green It’s no secret that type 2 diabetes is on the rise. According to the Centers for Disease Control, 1 in 3 people born in the United States in 2000 will develop diabetes in their lifetime. And over the next 50 years as those who develop diabetes continue to do so at a younger age, the number of people in nursing homes with diabetes will also increase due to the complexity of the disease in an aging population. “The fastest growing population of young people with diabetes is in this region,” says Rachel Holt, a second-year medical student at OU-COM. “Imagine the implications of this.” To examine the implications, Jay Shubrook, D.O. (’96), and Frank Schwartz, M.D., both affiliated with the Appalachian Rural Health Institute Diabetes Center at Ohio University, designed a research study to look at the quality of care diabetes patients receive in nursing homes. Holt joined the project in its early phase and was instrumental in its completion. The goal of the study was to examine physician management of patients with type 1 and type 2 diabetes residing in extended care facilities and to compare this management to the American Diabetes Association Standards of Care for outpatients. After reviewing patient charts of more than 100 elderly residents with diabetes in 11 nursing homes in Ohio and West Virginia, the researchers discovered that patients who had their diabetes under control either as outpatients or while hospitalized, had less success after entering a nursing home. Holt says an analysis of the data revealed the lack of a systematic approach to diabetes treatment in the facilities studied. The findings demonstrate that practice guidelines for this population are needed. Working closely with medical directors and directors of nursing, Schwartz and Shubrook are developing specific guidelines regarding the care of diabetes in the nursing home population. “The guidelines give physicians and nursing home staff a solid framework for developing treatment plans for this challenging population,” Shubrook says. “Phase 2 of the study, a second chart review of patients, will determine if following the treatment protocols results in quality of life changes for the residents.” This project is an excellent example of how the RSAF program gives medical students like Holt an opportunity to conduct valuable research. “I really enjoy research and had done basic science bench work, but I wanted to try clinical research,” she says. “And Dr. Shubrook’s project was a good fit. Next year I’ll be doing a family practice fellowship and will continue to work on phase 2 of the nursing home study.” As Holt’s research advisor, Shubrook gives her credit for the success of the project. He says she kept the project on track, analyzed the data and was the lead author on their research paper published in Diabetes Care. “The college is very supportive of research opportunities for students by helping us navigate our way through the process,” Holt adds. “Being here at OU-COM is advantageous. Through this experience and others, I’ll be better prepared to do my residency.” Holt RM, Schwartz FL, Shubrook JH. Diabetes Care in Extended Care Facilities: Appropriate Intensity of Care? Diabetes Care. 2007 Jun;30(6):1454-1458; DOI: 10.2337/dc06-2311. From left, Jay Shubrook, D.O., Rachel Holt and Frank Schwartz, M.D. 24 www.oucom.ohio.edu
“I really enjoy research and had done basic science bench work, but I wanted to try clinical research.” Curious Clinicians In an editorial in the New York Times, Susan Love, M.D., writes about the decline of “curious clinicians” in an age of increasingly complex medical and scientific research. What was common in the past—physicians who observed their patients and then went into the lab to test their hypothesis—is seldom practiced. Love advocates a return to medical research that begins with the patient and then leads to the lab. For nearly 30 years, the Research and Scholarly Advancement Fellowship (RSAF) has given selected OU-COM students an opportunity to conduct research. This ten-week summer program gives osteopathic medical students an introduction to scholarly work under the guidance of COM faculty members. And while not all research projects begin with the patient in mind, many do. Projects range from contributing to an ongoing faculty research project in the laboratory or clinic, to developing a review of a specific body of literature, or to an original research project designed by the student. In addition to conducting research, students are required to attend seminars on research-related topics, write a research paper and present a poster of their project during OU-COM’s annual Research Day held each fall quarter. This experience helps to set a strong foundation for future research they may pursue as clinicians. summer/fall 2007 25
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Page 31 and 32: and Friends Board Daryl Sybert, D.O
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DO - Ohio University College of Osteopathic Medicine

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